CMS Price Transparency Data

X-ray, pelvis

Facility: Salem Memorial District Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $178
  • Cash Discount Price: $167
  • vs. Medicare Baseline: 1.67x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Salem Memorial District Hospital is $178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $167. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.67x the Medicare baseline. Located in Po Box 774, Salem, MO.
Cash / Self-Pay
$167

Average discount available for prompt cash payment at this facility.

Insurance Median
$178

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $167 (156%)
Insurance Median: $178 (167%)
Cash: $167 (156% of Medicare)
Ins. Median: $178 (167% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Aetna $75 - $200 70%
Ambetter / Centene $75 70%
Blue Cross Blue Shield $75 - $211 70%
Humana $75 - $189 70%
Tricare $75 70%
Triwest $75 70%
UnitedHealthcare $75 70%
Veteran'S Affairs $75 70%
Healthlink $144 135%
First Health $178 167%
Mercy - C.B. Management Company/Joplin Supply Company $178 167%
Mercy - City Of Springfield $178 167%
Mercy - Clayco $178 167%
Mercy - Commerce Bank $178 167%
Mercy - Diversified Plastics $178 167%
Mercy - Employers Benefit Alliance $178 167%
Mercy - Evolutions $178 167%
Mercy - Fabick Cat $178 167%
Mercy - Firsthealth Network $178 167%
Mercy - Health Management Network $178 167%
Mercy - Health Systems Inc $178 167%
Mercy - Liberty Utilities/Empire District Electric $178 167%
Mercy - Life Church $178 167%
Mercy - Missouri State University $178 167%
Mercy - Prime Health Services $178 167%
Mercy - Quiktrip Corporation $178 167%
Mercy - Shinesolar $178 167%
Mercy - Springfield Public Schools $178 167%
Mercy - Springfield Remanufacturing $178 167%
Mercy - Sumnerone $178 167%
Mercy - Trailiner $178 167%
Mercy - Walmart Mercy Accountable Care Plan $178 167%
Mercy-American Healthcare Alliance $178 167%
Phcs $178 - $189 167%
Cigna $188 176%
Mercy - Compresults $200 187%
Mercy - Corvel Corporation $200 187%
Mercy - Novasys $200 187%
Mercy - Scurlock Industries $200 187%
Mercy - Usa Managed Care Organization $200 187%
Right Choice-Alliance $211 198%
Right Choice-Regular $215 201%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Po Box 774, Salem, MO 65560
  • CMS Rating: ★★★★☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals